Leibovici L, Konisberger H, Pitlik S D, Samra Z, Drucker M
Department of Internal Medicine, Beilinson Medical Center, Petah Tiqva, Israel.
J Infect Dis. 1991 Jan;163(1):193-6. doi: 10.1093/infdis/163.1.193.
In a survey of 296 episodes of gram-negative bacteremia in 286 patients (aged 13-99 years), four clinical variables were found to predict both significantly and independently the subsequent isolation of a multiresistant strain; hospital acquisition of the infection, antibiotic treatment before the bacteremic episode, endotracheal intubation, and thermal trauma as the cause of hospitalization. These variables were combined in an index that served to classify the patients into four groups with an increasing prevalence of multiresistant strains, Pseudomonas isolates, and isolates resistant to each of the antibiotic drugs in common use. For example, the percentage of isolates susceptible to cefuroxime in the four groups were 79%, 56%, 34% and 25%, and to gentamicin, 89%, 79%, 46%, and 33% (P less than .001 for both comparisons). The performance of the index was validated in a second group of 144 episodes of gram-negative bacteremia. The index kept its discriminative power. Compared with the prescriptions of the attending physicians, the index could probably have improved empiric antibiotic treatment in 24% of patients.
在一项针对286例患者（年龄在13至99岁之间）的296次革兰氏阴性菌血症发作的调查中，发现有四个临床变量可显著且独立地预测随后多重耐药菌株的分离情况；医院获得性感染、菌血症发作前的抗生素治疗、气管插管以及因热创伤住院。这些变量被纳入一个指数，该指数用于将患者分为四组，多重耐药菌株、假单胞菌分离株以及对每种常用抗生素耐药的分离株的患病率呈递增趋势。例如，四组中对头孢呋辛敏感的分离株百分比分别为79%、56%、34%和25%，对庆大霉素敏感的分离株百分比分别为89%、79%、46%和33%（两组比较P均小于0.001）。该指数的性能在另一组144次革兰氏阴性菌血症发作中得到验证。该指数保持了其判别能力。与主治医生的处方相比，该指数可能会使24%的患者的经验性抗生素治疗得到改善。
